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General NPI Number Information
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NPI Number | 1285711242
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Entity Type | Individual
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Provider Name | THOMAS J WELLE D.O.
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 02/02/2021
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Provider Practice Location Address
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Address Line | 2907 CHANTICLEER AVE.
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City | SANTA CRUZ
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State | CA
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Zip | 95065-1815
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Country | US
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Telephone | 831-477-2325
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Fax | 831-477-2330
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Provider Business Mailing Address
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Address Line | 325 DISTEL CIR
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City | LOS ALTOS
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State | CA
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Zip | 94022-1408
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Country | US
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Telephone | 831-476-0660
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 20A7124
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 20A7124
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License Number State | CA
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